14th March 2020, Dr Chee L Khoo
I have been holding off writing about the coronavirus so far as I didn’t think that I have the expertise. I would be out of my depth. It’s been coming up to three months since the world woke up to Wuhan. It’s been 6 weeks since Australia banned all flights from China. It was only a matter of time before the virus run rampant in Australia causing mayhem.…
14th March 2020, Dr Chee L Khoo
It’s more than 100 years since insulin was first use for patients with type 1 diabetes (T1D). It’s been many decades now since we discovered that autoantibodies pre-dates the development of hyperglycaemia and theoretically, we should be able stop destruction of the beta cells before the onset of hyperglycaemia and “prevent” T1D. Unfortunately, strategies from preclinical and clinical studies thus fat, have not met their primary end points.…
14th March 2020, Dr Chee L Khoo
Despite significant reduction in cardiovascular events over the last 20 years in the general population, patients with diabetes still has 1.5-2 times the risk of cardiovascular events and cardiovascular mortality compared with the general population. It was pretty exciting when two classes of the new anti-diabetic medications have been shown in a number of landmark trials to reduce composite cardiovascular events patients with type 2 diabetes (T2D) and previous cardiovascular disease or patients with T2D with multiple cardiovascular risks.…
Lantus® or Insulin glargine U100 is a vital tool in a significant number of our patients with type 1 and type 2 diabetes. It is the only once a day basal insulin available in Australia until recently. From the 1st July, it will no longer be available on the PBS. It’s going to be chaotic unless you are prepared for D-day.…
The Diabetes Control and Complications Trial (DCCT) demonstrated that intensive glucose lowering in patients with type 1 diabetes (T1D) reduce the risk of long term diabetes complications (1). Similar results were demonstrated in patients with type 2 diabetes (T2D) in the UK Prospective Diabetes Study (UKPDS). But intensive glucose control involves finger pricks at least 4-8 times a day and is not sustainable in the medium to long term in most patients.…
10th February 2020, Dr Chee L Khoo
Diabetes can either be the sole perpetrator of the heart failure or be an accomplice to other cardiac disease such as coronary artery disease or myocarditis. Diabetic cardiomyopathy can manifest itself either as a restrictive cardiomyopathy with heart failure with preserved ejection fraction (HFpEF) or as a dilated cardiomyopathy with heart failure wth reduced ejection fraction (HFrEF).…
29th January 2020, Dr Chee L Khoo
If you have someone in the family with type 2 diabetes (T2D), then your risk of developing diabetes significantly increases. How much is “significant” though? Is it 2 times, 3 times or is it 10 times? Does it matter how many members in the family have diabetes? Is paternal diabetes important too? Do we know the numbers?…
29th January 2020, Dr Chee L Khoo
The major difference between the 2018 American Diabetes Association/ European Association for the Study of Diabetes (ADA/EASD) consensus guidelines compared to previous guidelines were that they were less glucose centric in determining which agent to use after metformin. We used to use the most potent agent to get the sugars to target but increasingly, we are now looking at what other benefits the next agent has in addition to lowering glucose.…
5th January 2020, Dr Chee L Khoo
Athletes and highly active people are not immune to coronary artery disease. There are some studies which suggest that despite the high levels of physical activity, these individuals have a higher prevalence of coronary artery calcification (CAC) compared with controls with low atherosclerotic risks (1,2). Is this increased level of CAC associated with increased mortality?…
4th January 2020, Dr Chee L Khoo
Anecdotal evidence suggests that having a pet reduces cardiovascular mortality. Does it? You can imagine that trying to conduct a randomised control trial can be difficult. One has to consider the pre-existing risks profile of the pet owner, physical activity pre and post pet ownership, marital status of the owner and whether pet ownership benefits men or women more.…
12th December 2019, Dr Chee L Khoo
Type 2 diabetes (T2D) and heart failure (HF) are common diseases with significant morbidity and mortality. Two out of three patients with T2D have evidence of ventricular dysfunction within 5 years of diabetes diagnosis (1). Data from both observational studies and clinical trial cohorts suggest that the development of HF in patients with T2DM is associated with anywhere from a 4- to 10-fold increase in mortality risk (2,3).…
27th October 2019. Dr Chee L Khoo
In medicine, newer is usually better although sometimes, we can be sceptical whether “newer” means a sneaky way to extend patents. The newer, second generation insulins, Toujeo® (insulin glargine U300 or GLA-300) and Degludec® are truly better insulins. Diabetes Therapy recently published a practical guide to the use of these second generation insulins (1).…